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CM III Exam III > Afsoon's Lecture > Flashcards

Afsoon's Lecture Flashcards

1
Q

Which of the following is true regarding the T-Zone?

A) Area where cervical neoplasia originates
B) Border between the stratified squamous epithelium of the ectocervix and columnar epithelium of the endocervix
C) A and B
D) Endocervical canal

A

C) Both A and B

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2
Q

The clinical scenario when HPV integrates into the genome is called:

A) Latent infection
B) Active infection
C) Neoplastic transformation
D) All of the above

A

C) Neoplastic transformation

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3
Q

Which of the following is not a cofactor in HPV pathogenesis?

A) Immunosuppression
B) Herpes and Chlamydia
C) Smoking
D) All of the above are cofactors in HPV pathogenesis

A

D) All of them are

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4
Q

First step in cervical cancer pathogenesis?

A) Persistence of HPV infection
B) Progression of a clone of epithelial cells from persistent viral infection to pre-cancer
C) Oncogenic HPV infectino of the metaplastic epithelium at the cervical transformation
D) Development of carcinoma and invasion through the basement membrane

A

This one was stupid. I think it’s oncogenic HPV infection of the metaplastic epithelium at the cervical transformation

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5
Q

Which cervical staging system is largely based upon physical examination and a limited number of endoscopic diagnostic procedures and imaging studies?

A

FIGO

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6
Q

What is the frequency of cervical cytology screening for age 21-29?

A

Every 3 years

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7
Q

18 year old presents for OCP’s. She has had annual paps since her pregnancy at age 16. She has had 7 partners since age 15 and a new partner for 3 months. What would you advise her about cervical cancer screening?

A

Pap test and HPV testing at age 21

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8
Q

25 yo comes in for first cervical cancer screening. Assuming pap is neg, when is her next screening?

A

3 years, pap or HPV testing

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9
Q

31 yo has not had a pap in 3 years. What is the recommendation for cervical cancer screening?

A) Co testing (pap/HPV) now and in 5 years
B)HPV testing in 3 years
C) No screening now

A

A) Co testing (pap/HPV) now and in 5 years

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10
Q

69 yo woman has no hx of abnormal paps. What would you advise her about cervical cancer screening?

A

No further pap testing is necessary if a woman is >65 yo and they have adequate negative screening results

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11
Q

Is HPV a DNA or RNA virus

A

DNA

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12
Q

Is HPV sufficient to cause cervical dysplasia

A

No, while necessary there needs to be other cofactors involved for dysplasia to occur

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13
Q

High risk types of HPV

A

16 and 18 (16 is more common). These types of HPV are more likely to persist.

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14
Q

Low risk types of HPV

A

6 and 11

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15
Q

HPV in women <30

A

Much more prevalent but less persistent. Most young women can clear the infection on their own

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16
Q

HPV in women >30

A

Much less prevalent but more persistent.

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17
Q

Duration of infection and HPV persistence

A

The longer an HPV infection has been recognized, the longer it will take to clear (if it clears)

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18
Q

Primary site of HPV infection

A

Cervical transformation zone (T-Zone)

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19
Q

Carcinogenesis for cervical dysplasia

A

Infection of the transformation zone with an oncogenic HPV subtype

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20
Q

Most common sx in low-risk HPV

A

Genital warts

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21
Q

Most common sx in high-risk HPV

A

Premalignant/malignant lesions

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22
Q

What does ASC-US stand for

A

Atypical squamous cells of undetermined significance (pathology for “we don’t know”)

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23
Q

What is the Transformation Zone (T-Zone)

A

Border between the stratified squamous epithelium of the ectocervix and the columnar epithelium of the endocervix.

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24
Q

What is the clinical significance of the T-Zone

A

Cervical neoplasia originates here

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25
Q

Latent HPV infection

A

Clinically asymptomatic. There’s no physical, cytologic or histologic manifestations

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26
Q

Active infection

A

Not cancerous!! The HPV virus is undergoing replication, but it isn’t integrating itself into the genome. Patient is not asymptomatic with the active infection.

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27
Q

Neoplastic Transformation

A

When the HPV virus is either an episome or a neoplasm

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28
Q

HPV Episome

A

Virus is hanging out and living/persisting in the cytoplasm

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29
Q

HPV Neoplasm

A

HPV virus is actively integrating itself into the host cell DNA

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30
Q

What determines an individual’s susceptibility to oncogenic HPV types

A

Their immune system!

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31
Q

Cofactors in HPV pathogenesis

A

Immunosuppression, cigarette smoking, herpes/chlam, OCP’s

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32
Q

How is cigarette smoking a cofactor?

A

Breakdown products of cig smoke cause cellular abnormalities in the cervical epithelium/a decrease in local immunity

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33
Q

HPV RNA Testing- what oncoproteins are we looking for?

A

E6 and/or E7 RNA

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34
Q

What does E6 mess with

A

Functions of p53 tumor suppressor gene

35
Q

What does E7 mess with

A

Retinoblastoma protein

36
Q

What does ASC-H mean

A

Atypical squamous cells, we cannot exlude it being a high grade squamous epithelial lesion

37
Q

RF of cervical cancer

A 
Early onset of sexual activity
Multiple partner
High risk partner
Hx of STI
Hx of vulvar/vaginal neoplasia/cancer
Immunosuppression (HIV)
38
Q

What is co-testing?

A

Testing cervical cytology (pap) and HPV screening at the same time.

39
Q

What is Reflex HPV testing

A

Collecting a specimen for HPV testing after a pap has shown ASC-US results. ASC-US is undefined, but always needs more investigation

40
Q

LAST criteria

A

Lower anogenital Squamous Terminology. Way of labeling the cervical dysplasia. CIN 0-3

41
Q

CIN1

A

Low grade dysplasia. Active HPV

42
Q

CIN

A

Cervical intraepithelial neoplasia. If 0, premalignant

43
Q

CIN2

A

High grade dysplasia, active HPV

44
Q

CIN3

A

Really high grade dysplasia, active HPV. Synonymous with CIS (carcinoma in situ)

45
Q

When does CIS (carcinoma in situ) become metastatic

A

When it breaks through the basement membrane

46
Q

Two ways of staging cervical cancer

A

FIGO and TNM.

47
Q

FIGO scoring

A

Based on PE. More commonly used. No Stage zero!!

48
Q

TNM

A

Classic tumor grading

49
Q

Major prognostic factors affecting cervical cancer survival in women

A

Disease stage and LN status

50
Q

CIN Primary Prevention methods

A

Pap smears and HPV vaccination

51
Q

CIN Secondary Prevention methods

A

You have cancer at this point, we’re trying to keep it from becoming advanced and save your life.

52
Q

When is the HPV vaccine most effective

A

If you have never been exposed to HPV

53
Q

Who is the 9-valent HPV vaccine recommended for

A

Females aged 11-12. You can give it as early as 9 though

54
Q

Use for quadrivalent or 9-valent HPV vaccine

A

For prevention of anal cancer, precursor lesions, genital warts.
9-valent specific is cervical/vaginal/vulvar cancer

55
Q

Who is the “catch up vaccine” for?

A

Women aged 13-26 who have not been previously vaccinated or did not complete the vaccination series

56
Q

Getting the vaccine at <15 yo

A

2 HPV doses 6 months apart

57
Q

Getting the vaccine at >15 yo

A

3 HPV doses in a max of 2 years

58
Q

Pathogenesis of Cervical Cancer

A

1) Oncogenic HPV infection at the T Zone
2) Persistence of so-said HPV infection
3) Progression of viral infection to pre-cancer
4) Development of carcinoma and invasion into the basement membrane

59
Q

What two ways can cervical cancer spread?

A

Direct extension or by lymphatic/hematogenous dissemination

60
Q

What does spreading by “direct extension” mean?

A

Directly spreading to the uterine corpus, vagina, peritoneal cavity, bladder or rectum

61
Q

Clinical manifestations of cervical cancer?

A

Irregular/heavy vaginal bleeding and postcoital bleeding

62
Q

Steps to diagnosing cervical cancer

A

1) PE
2) Cervical pap cytology smear (GOLD STANDARD)
3) Have lesions or an abnormal pap? Do a colposcopy w/ directed bx
4) Suspected cancer but got nothing from the directed biopsy? Cervical conization time.

63
Q

What kind of lab tests do we want to order when considering cervical cancer?

A

CBC
LFT/RFT
UA
Tumor markers

64
Q

HPV vaccine in males?

A

Literally the same exact guidelines as for women. Routinely use quadrivalent vax

65
Q

Pregnant w/ ASC-US?

A

Defer colposcopy 6 weeks PP

66
Q

Pregnant w/ ASC-H?

A

Do not defer. Do the colposcopy, but do not do endocervical curettage. Just do it with the cytobrush, it’s wicked gentle.

67
Q

Most specific presentation of cervical cancer

A

Post coital bleeding.

68
Q

Pap screening reduction in cervical cancer MM

A

80%

69
Q

Where do we do a pap smear?

A

T zone

70
Q

According to ACOG, when should we start screening women?

A

> 21 years old. Young women were getting over txed for HPV infection that would almost always clear on their own

71
Q

According to ACOG, how do we manage women from age 21-29

A

We do either HPV or a cytology screening every 3 years

72
Q

According to ACOG, how do we manage women >30 years old

A

Either

1) Cotesting every 5 years
2) Same shit as when they were >21

73
Q

According to ACOG, when can we consider cessation of screening in a 65 year old woman

A

If the woman has had no previous HPV infection, 2 consecutive negative cotesting or 3 negative paps in the last 10 years

74
Q

According to ACOG, in what case would we keep screening a woman until she is 80 yo

A

If the patient has had any hx of CIN2 (high grade dysplasia)

75
Q

Methods of biopsying the cervix

A

1) Colposcopy
2) Cone biopsy (usually done during colposcopy, it’s gold standard!)
3) LEEP (Loop electrosurgical excision procedure)
4) Cryosurgery
5) Endocervical curettage (take out a little scoop)

76
Q

When do we do endocervical curettage

A

When endometrial/cervical cancer is suspeted or needs to be ruled out. Usually done during colposcopy

77
Q

Evaluating ASC-US in a woman >25

A

Reflex testing for HPV.

Negative? Do cotesting in 3 years
Postive? Colposcopy

78
Q

Evaluating ASC-US in a woman 21-24

A

Still young. Repeat the pap in 12 months.

Cytology negative/ASC-US or LSIL? Repeat the pap in another year. Do this for two years.

Cytology is ASC-H? Do a colposcopy

79
Q

Evaluating ASC-H in a woman >25

A

Do a colposcopy.

1) No lesion/CIN1? Do cotesting every year for two years. If both are negative resume routine screening. if HPV pos/HSIL do a colposcopy
2) CIN2 or CIN3? Treatment (LEEP)

80
Q

Evaluating ASC-H in a woman 21-24

A

Cytology & colposcopy every 6 months for a year.

1) Negative? Cotest in another year
2) Abnormal after one year? Repeat biopsy
3) Abnormal after two years? Tx. LEEP

81
Q

Evaluating CIN

A

Need follow up.

1) Persistent CIN1 for 2 years? LEEP
2) CIN 2/3? LEEP

82
Q

After treating CIN1/2/3 how should we follow up

A

Do cotesting once a year for 2 years

83
Q

Post LEEP management of CIN2/3

A

Co testing every 12mo/24mo.

1) Negative? cotesting is repeated in 3 years. Still negative? Rad, just go back to normal screening.
2) Postive cytology or HPV? Colposcopy w/ endocervical curettage.

CM III Exam III (8 decks)

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